Problems and Proposed Solutions for Medical Missionaries Coming from China

Navigating a Pathway to Sustainable Chinese Medical Mission Participation

Compassion ministries, including medical missions, have a long track record of effectiveness in missionary work. They demonstrate God’s unconditional love for people. They also meet a practical need, caring for people in action and in truth—not in word only (1 John 3:18). Medical mission work opens hearts making people more receptive to the gospel. It is one potential avenue the Chinese church might use in facilitating a forward missionary thrust.

However, Chinese physicians who want to be missionaries face significant challenges. I recently conducted three focus groups with a total of 14 Chinese Christian physicians who had previously participated in short-term medical mission service. From the perspective of these short-term missionaries, I will first discuss some difficulties prospective, long-term, Chinese medical missionaries face. Then, I will discuss possible solutions.

Problem #1: Medical Licensure

Focus group participants emphasized the difficulties in maintaining a Chinese medical license when a doctor leaves China. According to the Interim Measures for Physician Practice Registration, “For a doctor registered in any of the following circumstances, the institution …where he/she worked shall report to the department in charge of registration within thirty days, to cancel the registration if the doctor discontinues medical practice for two years.”[1] If licensure is canceled, a physician returning from missionary service would need to reapply for medical licensure in order to resume practice. Reapplication entails a variable length of training and testing as determined by each individual local health licensing administration.[2] Chinese medical licensure is put at risk by missionary service that extends continuously beyond a two-year period.

Problem #2: Maintenance of Continuing Medical Education

A further difficulty is how to obtain the required Continuing Medical Education (CME) readily available in China but not easily accessed when abroad. For a Chinese doctor at the “Attending Physician” level and above, “Category I credits,” approved by the national or provincial accrediting bodies, are required for professional advancement as a physician.[3] Tenuous opportunity to attend such CME when outside of China means that Chinese doctors leaving for long-term missionary service potentially sacrifice medical career advancement goals, a prospect not at all welcomed by focus group participants.

Problem #3: Loss of Medical Employment

In addition to licensing and CME issues, finding medical employment upon returning to China after missionary service can be challenging. In China, hospitals, as opposed to individual physicians, are the center of the health care system. After medical school, doctors all vie for positions at top hospitals which offer the best salaries and working environments. Highly valued “permanent contracts” with such hospitals are sometimes offered. A permanent contract gives physicians an added measure of security as they cannot be fired easily in cases of alleged misdiagnosis or malpractice. A physician exiting a permanent contract burns the relational bridge with that hospital. The physician would have no way to return to previous employment. A Chinese physician returning from completed missionary service would be an outsider to the Chinese medical system, likely needing to settle for a lower paying job in a weaker supporting hospital or clinic. Even if a Chinese physician is not leaving a permanent contract, opportunities to scale the professional “career ladder” are sacrificed by leaving the country for any significant length of time.

Problem #4: Difficulty Obtaining a Foreign Medical License

Obtaining a license to practice medicine in another country is a difficult process for a Chinese physician and may involve going through licensure testing either in a local language or in English.[4] One focus group participant held that obtaining an active local license would be contingent on maintenance of an active Chinese license which, as noted above, entails several difficulties and uncertainties. Focus group participants, nevertheless, voiced a strong desire to continue practicing medicine during proposed missionary service.

Solution #1: Non-Clinical Service

One option open to prospective Chinese medical missionarlies is to not practice medicine. Chinese medical missionaries could potentially focus on teaching, or for example, support the local Christian medical fellowships in countries of service. However, this option is unattractive to Chinese physicians.

Solution #2: Government Service

Another potential option for service available to Chinese medical doctors is the Chinese government program which employs Chinese doctors for international medical care. The Chinese government, as part of a diplomatic policy to build friendly transnational relationships, has a system for placing Chinese physicians in places like the Middle East or North Africa. Doctors who participate in that system enjoy a base salary with bonuses and promotion benefits. Medical licensure and registration are maintained by a supportive Chinese government.

Limitations on freedom to conduct gospel-centered activity make this option less attractive. Those who participate in the program are required to have a “high degree of political awareness.”[5] Some traditional missionary strategies directed toward indigenous peoples might need modification allowing for the context of government employment. Indeed, the Chinese government has no motivation to smooth the way for Chinese missionary activity. Further, only specialists from high-level government hospitals need apply. Finally, as the amount of time that a physician may commit to this medical service program is restricted to two, or at the most three years, this option may be at best an acceptable starting place for missionary service, but not an ideal long-term career option.

Solution #3: Joining Existing Teams of Western Medical Missionaries

A third potential platform for sustainable medical missionary service available to Chinese doctors is to join existing teams of Western medical missionaries who are already serving in target locations. However, joining a Western team poses several difficulties, including high expectations regarding levels of medical training and English language proficiency. Western missionaries who are already established on teams in host countries can be resources to a newly sent team from China. Nevertheless, Chinese medical missionaries serving together in a limited number of locations may prove more beneficial than scattering missionaries into a greater number of isolated locations where they then must find support from workers who are culturally and linguistically different.

Solution #4: Tentmaking Medical Clinics

In the wake of China’s economic rise, Chinese businessmen have relocated around the world, including strategic locations within the 10/40 Window. According to the Chinese Academy of Social Sciences, there are now 35 million Chinese living abroad, making Chinese the world’s largest migrant population.[6] Doctors who are tentmaking missionaries could go to serve these Chinese business communities, working in “international clinics” serving the Chinese business diaspora community currently scattered all over the Middle East, North Africa, and many central Asian nations.

Chinese doctors have expressed willingness to serve as tentmaking missionaries. Professional needs would necessitate frequent furloughs with at least some time spent in China every two years for medical practice in order to maintain Chinese medical licensure and to meet ongoing CME requirements. Local medical licensure must also be obtained in the country of service. Although many countries in the 10/40 Window refuse to license Chinese doctors to see patients from their general population, qualified Chinese doctors have been able to secure medical licenses to attend Chinese patients in these countries. Expat Chinese serving as doctors for expat Chinese businessmen makes sense to local governments. Chinese businessmen are, after all, more likely to settle and stimulate the economy of places where available health care providers understand their language, culture, and expectations. Secular Chinese international clinics serve as potential models, and these clinics have been able to provide Chinese doctors competitive compensation. Wages for Chinese physicians willing to serve abroad may be as much as two to three times the average wage for similarly trained Chinese physicians working within China.

Chinese tentmaking doctors can be trained in China using a medical and missiological curriculum. Teams of tentmaking doctors might enter 10/40 Window countries, establish profitable practices, learn the language, develop relationships with locals, and then be useful in Kingdom expansion work (including medical missionary service) through doors that God would open once the missionary community is firmly planted linguistically and culturally. Strategic partnerships with local churches and other missionaries can be formed to facilitate missionary objectives.

Tentmaking by means of international clinics will demand time from the Chinese medical mission worker, hindering language and culture acquisition and slowing the development of relationships with the local people that the mission worker wants to serve. Yet, tentmaking is still attractive in that it affords a path to local licensure, an ability for the physician to stay clinically sharp through on-going practice, an intelligible platform within a host country from which to begin building relationships, and, as a bonus, a means of generating needed revenue to cover living expenses that the local church in China may at this stage in its mission-sending development have difficulty raising. Further, tentmaking medical service is not incongruent with concurrent service through one or another of the developing Chinese missionary sending organizations. It can work in tandem with or independent of these sending structures, depending on the need.

Notes

  1. ^ The Central People's Government of the People's Republic of China, 2015. Interim Measures for Physician Practice Registration 医师执业注册暂行办法. China Ministry of Health, 2013, 1999 (cited May 8, 2015). Available from http://www.gov.cn/banshi/2005-08/02/content_19342.htm .
  2. ^ Standing Committee of the Ninth National People's Congress, 1998. The Law for Licensed Physician in People’s Republic of China. Issuing Department, Chapter 4, Item 31.
  3. ^ Ministry of Health of China 2007, Article 2.1, Category I Credits, Article 4.3, The Credit Registration and Examination, “Continuing Medical Education Credit Granting and Management Measures.” Available from http://www.cha.org.cn/plus/view.php?aid=8437
  4. ^ The situation is variable depending on the country. For example, Chinese licensed physicians can reportedly become medically licensed relatively easily in Zimbabwe, though local officials might ask for bribes. In Cambodia, Chinese medical licensure is recognized and is sufficient to practice medicine.
  5. ^ People's Republic of China Ministry of Health Bulletin. 2015. Ministry of Health Issued Advice to Further Strengthen and Improve the [Chinese] International Medical Teams (Chinese Government Public Information Online). Ministry of Health (China) 2008 (cited April 25, 2015) Item 7. Available from http://govinfo.nlc.gov.cn/gtfz/zfgb/wsb/20084057/201010/t20101011_447025.html?classid=434
  6. ^ Embassy of the People's Republic of China in the United States of America. CASS Report: Number of Overseas Chinese up to 35 Mln. Embassy of the People's Republic of China in the United States of America 2015 (cited 2/24/2015). Available from http://www.china-embassy.org/eng/qwgz/t297510.htm.